Achilles Tendonitis & Achilles Tendinopathy / Tendonoses

Achilles Tendonitis & Achilles Tendinopathy

 One of the challenges we face when someone presents to us with Achilles heel pain problems is they received treatment for Achilles Tendonitis when they have Tendonoses or Achilles Tendinopathy.

First, the correct diagnoses needs to be made.  Second, the cause needs to be found.  Third, the correct treatment needs to be prescribed.

Achilles Tendon Inflammation vs. Degeneration

The term Achilles tendonitis should be used to refer to inflammation of the Achilles tendon. Inflammation is most often an acute change (the result of a sudden injury). This problem is characterised by swelling, redness, warmth, and pain. When seen under the microscope, inflammatory conditions have specific cells that the body brings to that area of the body to help control the inflammation and heal the injured tendon.   

What is Achilles tendonitis?

Achilles Tendinosis or Achilles Tendinopathy is a very different condition that is not characterised by inflammation. Rather, these patients have thickening of the tendon. There is usually no redness or warmth of the surrounding tissue, although the area can be painful to touch.

Achilles tendinosis is a chronic problem, meaning it develops gradually and lasts a long time. When seen under a microscope, inflammatory cells are not present, although chronic damage and microscopic tears of the tendon may be seen.  We have seen people come to use who have been prescribed anti-inflammatory drugs which are not going to work when there is no inflammation or have been told to ice it, but it not an acute injury and does not require ice.

Achilles Tendon Treatment

We have a good understanding of the fundamental differences, are capable of diagnosing the condition and conduct a thorough bio-mechanical assessment to find out why it occurred in the first place. Then, and only then, can we recommend a successful treatment.

Rest, Ice, Compression and Elevation are short term interim measures that can be taken to alleviate the symptoms, however a thorough assessment by our Podiatrist is recommended due to the fact that this can be a long term debilitating injury. The worst case scenario is a complete rupture of the tendon, requiring surgery and many months of rehabilitation and time off work.

Why can it be a long term injury?

Firstly, the Achilles tendon has relatively low blood supply and cell activity, so the chance of it healing without intervention is low. Secondly, unlike a wrist injury for example, which can be rested in a sling while it heals, most people will continue to walk around the house, drive to pick up the kids from school, stand and cook dinner and make lunches, all of which can cause micro-injury to an already inflamed site. Given most people are not in a position to put their feet up for 6 weeks, seeing our Podiatrist will speed up the healing process.

 What about Surgery?

Surgery is required if there is a complete rupture. If there is not a complete rupture, all other treatment options should be explored first.